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Safety concerns over ‘barbaric’ shift patterns and lack of breaks


Nursing staff are frequently unable to take their breaks, are having to stay behind at the end of work and are being given “barbaric” rotas with back-to-back day and night shifts, which is putting both them and their patients at risk, it has been warned. 

Members of the Royal College of Nursing speaking at the union’s annual congress in Liverpool today said employers were largely to blame, because these practices were occurring due to their failure to deal with service pressures and staffing gaps.

“We have regular late-early-late-early shifts in succession…you don’t know whether you are coming or going”

RCN member 

They said that in some cases the practice amounted to a breach of laws by employers under the UK’s Working Time Regulations, which include requirments such as a 20-minute break for every six hours of work and an 11-hour rest period between long shifts.

Others also suggested some nurses were opting to work for longer – sometimes more than 60 hours per week – to increase their wages, because nursing salaries were so low.

Another nurse highlighted that in the independent sector staff often had their break time deducted from their wages, regardless of whether they took them or not.

One nurse warned that the situation could worsen following Brexit because the UK laws protecting rest breaks had come from European legislation, which meant they could be lost.

Meanwhile, concerns were raised that student nurses were working long hours on clinical placements, alongside paid jobs, which was affecting their learning.

“Employers should be held to account for their employees being unable to take adequate rest breaks”

Denise McLaughlin

In addition, during a separate session this week at the conference, a nurse from an NHS trust in Oxfordshire described “barbaric” shift patterns at her organisation, which was causing burnout among staff.

“We have regular late-early-late-early shifts in succession. And by the time you get to that fourth day you don’t know whether you are coming or going,” she said. “We regularly finish late on the late shift.

“The employer thinks they can get away with it by saying ’you need to go home’ while, as nurses, we all know if you’ve got write-ups to do or are still in handover or, if you’re liaising with doctors because you’ve got problems with your patients, you don’t go home because you are dealing with the situation,” she added.

During a congress debate on the issue of working patterns today, Denise McLaughlin – chair of the RCN’s UK safety representatives’ committee which put forward the issue – highlighted a recent RCN survey which found many nurses has been on shifts “without even being able to take a break to use the toilets”.

“These nurses were working multiple part-time contracts. This is a symptom…of low pay”

Garry Campbell

“These nurses were working multiple part-time contracts and had a zero hour contract,” said Garry Campbell.

“This is a symptom of a disease. The symptom of low pay, staff having to take multiple contracts, staff needing this money to make ends meet,” he added.

Marie Rogers, from the RCN’s Northern Region, said that when she previously worked as a team leader of a district nursing team she would regularly leave two to three hours late “just so I could get through my daily visits and carry out my management duties”.

She said she was told this was bad time management by colleagues, but she told today’s conference that “no, this was bad staffing levels”.

“We should not be made to feel bad for taking time off in lieu, nor should we feel bad for taking any unpaid lunchtime breaks, or leaving on time,” she said.

“We need to make sure our [NHS] trusts acknowledge unpaid work..but we must [also] stop being martyrs”

Marie Rogers

“We need to make sure our [NHS] trusts acknowledge the unpaid work we do but likewise we must take some responsibility for our actions and stop being martyrs,” added Ms Rogers.

Later, a healthcare assistant who had in the past worked patterns of consecutive long shifts warned nurses in the same position that this could put their registration at risk.

“At my previous employer, a shift pattern that found myself on quite often was going from a late to an early, or a late onto a long day of 14 hours, then back onto an early,” said Leslie Green.

“Some people have said we shouldn’t have days and nights in the same week and we shouldn’t do a run of long shifts – but I choose to do that”

Helen O’Boyle

“I was doing that as an HCA and I was absolutely washed out and exhausted. I’m not making drug calculations as nurses are. Surely that means your employer is putting your PIN, your livelihood, at risk,” he told the conference.

However, one nurse highlighted that it suited some staff to work long shifts back-to-back.

Helen O’Boyle, from the RCN’s North Central Inner London branch, said: “We’ve all got a choice. Some people have said we shouldn’t have days and nights in the same week and we shouldn’t do a run of long shifts – but I choose to do that.”

Following the debate, the RCN congress overwhelmingly passed a motion calling on the RCN council to “challenge vigorously employers who fail in their duty to comply with working time regulations”.

Resolution submitted by the RCN UK Safety Reps committee 

That this meeting of RCN Congress asks Council to challenge vigorously employers who fail in their duty to comply with working time regulations.


Readers' comments (8)

  • Here we go again. This is a depressingly old story which evokes happy memories of working shifts of over 14 hours with 20 minute breaks. To some degree we can blame employers but the reason for these practices are twofold: employers (as we know) in the private and NHS are quite happy to exploit nurses vocational sensibilities so that they will willingly work through their breaks and long after their roistered finishing times. Who hasn't? Who would walk off with work unfinished?

    All well and good and very noble also. But it leads to the second reason for these "barbaric" practices happening. I'm talking about the active complicity of nurses and their managers who will regularly forgo their allocated breaks and accept the inevitability of staff finishing long after the end of their shifts. Oh certainly we complain about it but that's not the point is it? We DO it in our thousands of hours until we make a mistake or we collapse due to physical exhaustion, stress and/or a weakened immune system. Throw in a punitive regulator that is uninterested in little things like short staffing or barely workable nurse/patient ratios and you have a recipe for disaster.

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  • The employers are only concerned about the bottom line and to provide a service that can run on the minimum staff they can get away with legally and the nurses are expected to do the jobs of three nurses and if they fail they are accused of 'poor time management' as the problem. The euphemism 'challenging environment' for lack of staff is used by employers to account for their penny pinching poor money management rather than employing directors of work force improvement and transformation it would make much more sense to just employ qualified nurses and pay them all on Band 6 - a living wage.. Instead the NHS is clearly re arranging the chairs while the NHS titanic sinks from the iceberg of poor nhs management.

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  • Time for all previous Tory supporters to vote Labour on June 8th?

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  • I am afraid you are in for a shock if you think a Labour government will wave a wand and all will be well in the NHS. The problems as I have said elsewhere is that it is like arranging a party without knowing how many people are coming. And I am afraid their sums do not add up, and of course they know it. Anyway time will tell.

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  • The other strong driver for the 'long day' shift pattern is nurses themselves. Its very common for nurses to insist on a long day shift pattern either because of minimising travelling time in a week, or to maximise their time off. Nurse managers cant win!

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  • The main problem for decreased staff numbers working to care for patients , and care of patients suffering is that the nurse training is university based.
    Long 12 hour shifts are difficult for older nurses , nurses having to work until they get their pensions over the age of 65.
    Nursing is a physical job ...older nurses are suffering .
    No nurse can possibly work 12-14 hours and be as effective by the last few hours of the shift. This puts patients safety at risk and nurses health /wellbeing at risk.

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  • I read in the article that on a late to early pattern by day 4, the nurse was exhausted. Day 4? Try day 10! The first comment was spot on. Nurses have been complicit in their own exhaustion for years, in the name of vocation. As have the unions, as have the management and successive governments. I work long days because it suits me to have more time off. That said, there are weeks when I do not have two days off together; equally exhausting. Nurses need to strike, it is that simple.

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  • They should ban 12 hour shifts full stop

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